Targeting Supervisors to Create Child Welfare System Change: R3 Supervision Model

Background and Purpose

Numerous empirically supported behavioral health preventive interventions show improved outcomes for high-risk children and families, yet few are assimilated into public service systems enough to have a measurable public health impact. Doing so often requires organizational cultural change within the workforce. R³ was born out of a request by a large child welfare system (CWS) to train their workforce in the use of evidence-based principles in their every day interactions with families. R³ draws from three areas of reinforcement shown across child and family EBPs to produce positive outcomes: Reinforcement of (1) effort, (2) relationships and roles, and (3) small steps toward goal achievement. The aim of R³ is to expose families to these three Rs in each interaction with their caseworkers to bolster positive progress toward completing CWS treatment plans, create a positive culture to sustain evidence-based principles, and to yield a significant public health impact by improving system-level outcomes related to child permanency and placement stability. A supervisor targeted implementation strategy was used to maximize the potential reach across the system, while working under the real-world limitations of training and coaching capacity.

 Method

A recent state-initiated rollout of R³ is underway providing a real-world opportunity to evaluate the R³ strategy and examine potential system level impacts. Observation-based, rapid, fidelity monitoring and feedback facilitates the potential for efficient system-wide behavior change.

Following training in the R³ model, supervisors met a minimum of once monthly with their supervisee caseworkers for group supervision. Supervision sessions were video recorded and uploaded to a secure web-based fidelity monitoring system for review by an R³ expert coach. Coaches provided monthly observational monitoring and fidelity rating, written feedback, and virtual consultation. Supervisors were coached to use R³ in their interactions with caseworkers and to support the caseworkers to use R³ with their families.

Results

Four cohorts of CWS staff including regional leadership, supervisors, and caseworkers were trained in R³ strategies and principles between September 2015 and February 2016 (n = 355). Lessons learned regarding system collaboration and large-scale rollout will be shared, including workforce considerations (e.g., inability to take entire workforce offline for training, meeting supervision policy requirements) and the need for flexibility to address system contexts. While supervisors and caseworkers reported high levels of satisfaction with the training, both groups reported ambivalence toward implementing the R³ supervision approach. Quantitative survey data regarding organizational culture, climate, leadership, and readiness to adopt EBPs will be combined with qualitative reports from supervisors engaged in the R³ process. This presentation will describe change on these measures from baseline.  Moreover, change in fidelity scores over time will be described.

Conclusions and Implications

The R³ supervisor strategy was developed to improve interactions between families and the CWS. By infusing evidence-based strategies into everyday interactions between CWS staff and the families they serve, there is an increased potential for quality and timely service plans to be achieved ultimately leading to improved child and family outcomes.